With its tenth case reported, health unit stresses critical need for social distancing, other measures

On March 23, 2020, Simcoe Muskoka District Health Unit (SMDHU) reported its 10th case of COVID-19, a woman in her 60s from New Tecumseth. This case is related to travel and the woman is recovering at home.

With that announcement, Dr. Charles Gardner, the medical officer of health for SMDHU, stressed that this is a critical time for people in the region to help flatten the curve of the pandemic, and offered other details about testing and measures being taken within the healthcare system.

“I’m very aware of the need to flatten the curve, as we say, and that means everybody abiding by the social distancing practices we are promoting so that we can really reduce the transmission in our community,” said Gardner in a virtual media conference. “And keep the numbers as low as possible to avoid overwhelming our healthcare system, to avoid the tragic circumstances that have happened in Italy and certain other European countries and originally in China.”

That means keeping at least a two-metre distance from others, frequent and thorough handwashing, avoiding crowds and avoiding interacting with people who are ill, and self-isolating at home if you have symptoms or if you have been notified by the health unit that you may have been in contact with a laboratory-confirmed case. If you are returning from travel out of the country, go immediately home—no stopping to stock up on supplies—and stay in home isolation for 14 days, and remain there if you develop symptoms at which point you should seek medical advice by phone through Telehealth Ontario, your primary care physician or practitioner, or public health.

If you do need to call the health unit, expect a long wait—wait times currently can be up to several hours and staff are working through calls as quickly as they can. You can also send an email with questions to the health unit. Updates on recommended practices are posted at smdhu.org/covid19.

An update on testing

Gardner said that demand for testing within the province has outstripped availability, and that means prioritizing who is tested.

“Our focus on testing even in [cases of people who have travelled outside the country] will be on individuals who certainly are developing severe symptoms in which case they should also be looking to be assessed in the emergency department. Or people who work in healthcare or have work in environments that could expose vulnerable people—in those cases they would definitely be priority for assessment and testing.”

Even without testing, people who develop any flu-like symptoms should remain in home isolation until they have fully recovered—that means at least 24 hours after all symptoms are gone—before venturing out.

Extending that recommendation to anyone experiencing flu-like symptoms is “a safeguard,” said Gardner, “because as this transmits in the community, we will get to the point where there are potentially many others in the community who won’t have an obvious link. And our ability to test them all is going to be very limited. The really key thing isn’t so much testing them all, it’s that they be isolated while they’re recovering…to avoid infecting other people, and that they seek medical attention if they are developing severe symptoms.”

As for the speed of testing, Gardner said that “the volume of testing has exceeded the capacity of the Ontario public health laboratory system to keep up with at this time and so there is some lag—up to six days of lag—in getting the results back. They are working diligently with other hospital laboratories to build up the province’s capacity to be able to do testing more quickly.”

He gave credit to Public Health Ontario for the work they’ve done so far, and said that “they’ve actually managed to do more testing than all of the testing that’s been done in the entirety of the United States.”

What about people who aren’t being tested?

Dr. Gardner said that it’s clear to him that there are more cases within Simcoe Muskoka than the 10 laboratory-confirmed cases reported to date.

“Because there always is, there’s always this tip of the iceberg phenomenon with surveillance—you know of some and you know there’s others that you just don’t have tests on. Either they’re waiting for the results, or they have a mild symptomatology, or even possibly no symptomatology. And so they haven’t come forward to be tested.” He added that the number could be as much as 10 times higher based on data from other infections like influenza.

How many people are likely to be infected?

Gardner said that they have applied a model developed at the Dalla Lana School of Public Health at the University of Toronto, and by that model the worst-case scenario is that “perhaps 50 per cent of the population could be infected at some point through the pandemic. And by putting in place strong social-distancing public
health measures early, you can reduce that by as much as 95 per cent according to the model. So, instead of having over 200,000 cases, you could have much, much less—10,000 or less cases. That still sounds like a very large number, of course, but it’s considerably less than no action taken or no timely action taken. And certainly much better for the concept of flattening the curve and avoiding exceeding capacity to respond.”

He urged those in places where there are not yet laboratory-confirmed cases—like Muskoka—not to become complacent. “I think it’s important that people everywhere in the province assume it’s coming. If you haven’t seen it yet, it is coming.”

How long will this pandemic last?

Two questions on the minds of many people are how long will these measures to control the spread of COVID-19 be necessary, and how long will the pandemic last.

That’s an unknown at this point, said Dr. Gardner, while acknowledging that measures like social distancing and self-isolation are difficult to maintain long-term. “This is a new virus and no one can know for sure,” he said. “The pandemics of the past have been from influenza. And typically, influenza pandemics, such as the Spanish Flu of 1918-1919 lasted in three waves over a year-and-a-half… So we could be in this in repeated waves for a long time. For months? Maybe a year? I certainly hope not. But I think we have to think in terms of how can we get through something like that, collectively together.”

A vaccine for COVID-19 could be a year away still, and even once we get to a point where the number of cases is dropping there will remain the need for vigilance, said Gardner. “If the majority of the population still hasn’t been infected, still doesn’t have immunity, then it can easily come back. So it can be a long, difficult, and drawn-out process for us that waxes and wanes.”

What’s important is to flatten the curve to stretch out the cases entering the healthcare system. “Our case survival rates will be much better if we can avoid a big surge, because it’s a big surge that makes it very difficult to treat those with complications if you’re exceeding the capacity of the system,” said Gardner.

What more needs to be done

“I think a lot has been done, but we need to do more,” said Gardner. “This is our opportunity now to flatten the curve. This is the point that we need to do it before it becomes well entrenched in our community. I think it’s really wise as government to be acting now, it’s wise of municipalities that are considering activating or declaring an emergency for the purposes of drawing attention to this and maybe taking further action with it. Now is the time to be considering such action.”

More could be done if needed, he added, citing lockdown measures in countries like Italy as an example. “My message would be, let’s do all we can with what we have now, with the measures we have before us now, to avoid having to go there.”

The SMDHU has resources for the public on its website, including a COVID-19 overview as well as a page on What you can do.

For ongoing updates on COVID-19 news and its affect on the Huntsville-area community, check our COVID-19 page regularly.